Asthma control assessment using asthma control test among patients attending 5 tertiary care hospitals in Saudi Arabia.
Al-Jahdali HH, Al-Hajjaj MS, Alanezi MO, Zeitoni MO, Al-Tasan TH.
Saudi Med J. 2008 May;29(5):714-717.
Abstract: OBJECTIVE: Evaluation of asthma control using the Asthma Control Test (ACT). METHODS: The ACT was used to assess asthma control among patients with bronchial asthma visiting pulmonary clinics in 5 major tertiary care hospitals in Riyadh, Kingdom of Saudi Arabia. Each hospital had a target of 300 patients to recruit over the period of the study from the 1st September to 30th November 2006. RESULTS: The total number of patients studied was 1,060 patients. Males constituted 442 (42%) and females constituted 618 (58%), the median age was 38.56 years (range 15-75). One third of patients had no formal education. The ACT score revealed uncontrolled asthma in 677 (64%), well-controlled asthma in 328 (31%), and complete controlled in 55 (5%). There are no significant correlations between the age below 40 and above 40 years and level of asthma control (p=0.12). However, the younger age group less than 20 had better control of asthma in comparison with older patients (p=0.0001). There was a significant correlation between level of asthma control and gender, males (44%) had better asthma control than females (30%) (p=0.0001). CONCLUSION: Control of bronchial asthma is still a major concern in our population. Further studies are needed to explore the factors leading to poor asthma control.
Acceptance of Asthma control test by saudi Patients.
Alanazy M. AL-Jahdali H, Al-Hajjaj MS, et al.
Submitted 2008
Abstract: To Follow
Genetic heterogeneity of Mendelian susceptibility to mycobacterial diseases.
Al-Muhsen, S; Casanova, J L.
J Allergy Clin Immunol. Dec 2008; 122(6):1043-1051
Abstract: Primary immunodeficiencies (PIDs) were long thought to be exclusively recessive traits -- autosomal recessive (AR) in most cases, with a few X-linked recessive (XR) diseases. In recent years, autosomal dominant (AD), mitochondrial, polygenic, and even somatic PIDs have been described. However, AR remains the most frequent inheritance pattern among recently described PIDs. Some PIDs have been shown to be genetically heterogeneous. Mendelian susceptibility to mycobacterial diseases (MSMD) displays a high level of genetic heterogeneity. There are 6 MSMD-causing genes, including 1 X-linked gene (nuclear factor-kappaB-essential modulator [NEMO]) and 5 autosomal genes (IFN-gamma receptor 1 [IFNGR1], IFN-gamma receptor 2 [IFNGR2], signal transducer and activator of transcription 1 [STAT1], IL-12 p40 subunit [IL12P40], and IL-12 receptor beta-subunit [IL12RB1]). The X-linked trait is XR; STAT1 deficiency is AD; the IFNGR2, IL12P40 subunit, and IL12RB1 deficiencies are AR; and IFNGR1 deficiency may be AD or AR. Two of the AR traits (IFNGR1, IFNGR2) may be subdivided into complete and partial deficiencies, and 3 AR complete deficiencies (IFNGR1, IFNGR2, IL12RB1) may be subdivided into disorders with and without cell surface expression. Finally, there are 2 types of AD STAT1 deficiency, depending on whether the mutation impairs phosphorylation or DNA binding. Thirteen genetic disorders conferring MSMD have been described, involving 1 XR, 3 AD (2 genes), and 9 AR traits (4 genes). However, no genetic etiology has yet been identified for about half of all patients with MSMD. We expect to identify new XR and AD causes of MSMD, but new AR etiologies of MSMD are also likely to be discovered. The investigation of children from areas in which consanguineous marriages are common will probably facilitate the description of many more AR traits.
The expression of stem cell factor and c-kit receptor in human asthmatic airways.
Al-Muhsen SZ, Shablovsky G, Olivenstein R, Mazer B, Hamid Q.
Clin Exp Allergy. 2004 Jun;34(6):911-6.
Meakins-Christie Laboratories, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
Abstract: BACKGROUND: Asthmatic airways are characterized by infiltration with a variety of inflammatory cells such as mast cells and eosinophils. Stem cell factor (SCF) is an important activating and chemotactic factor for both mast cells and eosinophils. In addition, it is a critical growth and differentiation factor for mast cells. OBJECTIVES: To investigate the contribution of SCF to the pathogenesis of asthma, we examined the expression of SCF and its receptor c-kit in bronchial biopsies and bronchoalveolar lavage (BAL) specimens obtained from asthmatic subjects (n=13) and non-asthmatic control subjects (n=10). METHODS: SCF and c-kit were detected by in situ hybridization (ISH) and immunocytochemistry (ICC). In order to phenotype the cells expressing SCF and c-kit in asthmatic tissue and BAL cells, combined ISH and ICC were also performed. RESULTS: There was a significant difference (P<0.001) in the SCF mRNA expression in asthmatic airway epithelium (70.38+/-12.33% positive cells) compared with controls (12.7+/-17.21% positive cells). There was also a significant difference in subepithelial SCF-mRNA expression, being higher in asthmatics (P<0.001). A significant difference was also found in c-kit receptor mRNA expression in asthmatic biopsies both in epithelium (P<0.001) and subepithelium (P<0.05) compared with controls. ICC results were consistent with the ISH for both SCF and c-kit receptor from asthmatics and controls. The SCF and c-kit receptor mRNA and immunoreactivity in cells recovered from bronchial washing were also significantly higher in asthmatics compared with controls (P<0.05). While SCF expression was localized predominantly in the epithelial layer in bronchial biopsy tissues, alveolar macrophages were found to be the major source of SCF in bronchial washing from asthmatic subjects. CONCLUSION: The results of this study demonstrate the increased expression of SCF and its receptor, c-kit within human asthmatic airways, which suggests an important role of this cytokine in the pathophysiology of asthma.
Oxidative DNA damage and its relation to the oxidative stress in Saudi Asthmatic Patients.
Al-Afaleg N, Al-Senaidi A, Al-Ansari A, Al-Enezi M, Al-Muhsen S*
(Accepted as oral presentation at the KSU postgraduate research day. Oct, 2008, Riyadh, Saudi Arabia)
Abstract: Background: Gene-Environment interaction play major role in pathogenesis of asthma, Oxidative stress as one application of such interaction is often measured by the damage inflicted by oxygen radicals on various molecules such as DNA, proteins, and lipids. In the present study, we investigated for the first time the role of 8-oxo-deoxyGuanosine (8-oxodG), an oxidative DNA damage marker in the serum of asthmatic patients. Other oxidative stress biomarkers as lipid peroxidation product, malondialdehyde (MDA); and a nitric acid metabolite were also measured. Methods: A total of 50 Saudi asthmatics and 50 healthy control subjects were enrolled in the study. All were nonsmokers and are not on vitamin supplementation. Serum levels of 8-oxo-dG were measured by ELISA; whereas the MDA levels were measured using TBA, and nitrite were measured using Griess reaction. Results: Oxidative DNA damage marker measured by serum level of 8-oxodG was higher in asthmatics compared to control (50.29±3.7 ng/ml Vs 42.8±3.2 ng/ml; P=0.0001; 95%CI, 45-48). Similarly, the MDA levels and nitrite were higher in asthmatics compared to control subjects (29.09±4.6 nM/ml Vs 13.7±0.5 nM/ml; P=0.001; 95%CI, 19-23; and 39.2±4.8 µM/ml Vs 27.8±2.9 µM/ml; 95%CI, 31.9-34.8) respectively. Conclusion: We document for the first time increased DNA oxidative damage in asthmatic patients. Other oxidative stress markers are also increased in asthmatics.
Levels of two Systemic Antioxidants in Saudi Asthmatic Patients.
Al-Afaleg N, Al-Senaidi A, Al-Ansari A, Al-Enezi M, Al-Muhsen S*
(Accepted as poster presentation at the KSU postgraduate research day. Oct, 2008, Riyadh, Saudi Arabia)
Background: Although there is ample evidence on the role of oxidative stress in asthma pathogenesis, the information on antioxidants is limited. Several reports showed alteration in level of antioxidants in asthma. Reduced glutathione is a key antioxidant in the lining fluid of the respiratory tract and has scavenging properties for oxygen radicals. Ascorbic acid has been shown to possess a whole array of antioxidant properties in vitro; it scavenges reactive oxygen species (ROS), prevent lipid peroxidation, and regenerate other antioxidants, such as uric acid and α-tocopherol. In this study, we measured the levels of reduced glutathione and ascorbic acid in asthmatic patients. Methods: A total of 50 Saudi patients with bronchial asthma and 50 non- asthmatic control subjects were included in the study. All were nonsmokers and not on vitamin supplementation. The levels of antioxidants, ascorbic acid and reduced glutathione, were measured in the plasma by spectrophotometry.Results: Asthmatic patients showed significantly decreased levels of plasma reduced glutathione and ascorbic acid concentrations compared with the control subjects (14.1±0.8 µg/ml Vs 16.6±1.7 µg/ml; P=0.0001; 95%CI, 1.9-3; and 24.9 ±2.2µg/ml Vs 28.2±2.2µg/ml; P=0.0001; 95%CI, 1.9-4.6) respectively. Conclusion: Asthma is associated with decreased levels of antioxidants as reduced glutathione and ascorbic acid; their therapeutic roles need to be investigated in large randomized clinical trials.
